Korean Circ J.  2012 Nov;42(11):776-780. 10.4070/kcj.2012.42.11.776.

A Case of Primary Cardiac Lymphoma Mimicking Acute Coronary and Aortic Syndrome

• Cho SW
• Kim BK
• Hwang JT
• Kim JH
• Kim BO
• Goh CW
• Rhee KJ
• Ahn HS
• Kim HJ
• Byun YS

• KMID: 2224979
• DOI: http://doi.org/10.4070/kcj.2012.42.11.776

Abstract

Primary cardiac lymphoma (PCL) is a rare disorder, but the incidence is increasing and its clinical manifestations are various. We report a case of PCL, which mimics an acute coronary and aortic syndrome. A 51 year-old female was presented with chest pain radiating to the back. Her initial electrocardiogram revealed T wave inversion in the leads of V 5-6, II, III and aVF. Additionally, cardiac troponin-T was slightly elevated. Chest radiography showed marked mediastinal widening. Computed tomography scan showed a huge pericardial mass. The histopathologic findings of the mass were compatible with diffuse large B cell lymphoma. She died of refractory ventricular tachycardia, probably, due to an extensive infiltration of PCL to the myocardium.

Keyword

Cardiac tumor; Chest pain; Acute coronary syndrome

MeSH Terms

Acute Coronary Syndrome
Chest Pain
Electrocardiography
Female
Heart Neoplasms
Humans
Incidence
Lymphoma
Lymphoma, B-Cell
Myocardium
Tachycardia, Ventricular
Thorax
Troponin T
Troponin T

Figure

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  Fig. 1 Initial electrocardiogram revealed T wave inversion in leads V 5-6, II, III and aVF.

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  Fig. 2 Chest radiography findings: (A) increased opacity of periaortic area was observed and mediastinal widening was markedly progressed in chest radiography compared to (B) chest radiography at 1 year ago.

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  Fig. 3 Chest computed tomography scan showed (A and B) multilobulated soft tissue mass (arrows) and (C) enlarged lymph nodes (arrows). A and C: coronal view. B: sagittal view.

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  Fig. 4 Coronary angiography findings. A: significant tubular eccentric stenosis (arrows) was observed in distal left circumflex artery on coronary angiography. B: right coronary artery was nearly normal.

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  Fig. 5 Histopathologic findings. A: the low power view of microscopic findings reveals entirely efffaced nodal architecture (HE stain, ×40). B: the high power view discloses monotonous large cells with scanty cytoplasm and hyperchromatic nuclei (HE stain, ×400). C, D and E: immunohistochemical stainings are as follows: CD20 (+) (C), BCL2 (PARTLY +) (D), Ki-67 labeling index (95% positivity) (E) (×400). F: EBV-ISH shows diffuse positive reactions (×400). BCL2: B-cell leukemia/lymphoma 2, ISH: in situ hybridization, HE: Hematoxylin eosin, EBV: Epstein-barr virus.

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